Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):E919-E928. doi: 10.1002/ccd.29383. Epub 2020 Nov 11.
To compare the predictive performances of the prewiring, postwiring MI-SYNTAX scores, prewiring, and postwiring Updated Logistic Clinical SYNTAX score (LCSS) for 2-year all-cause mortality post percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients.
In patients with STEMI and undergoing primary PCI, coronary stenosis(es) distal to the culprit lesion is often observed after the restoration of coronary flow. To address comprehensively the complex coronary anatomy in these patients, prewiring and postwiring MI-SYNTAX scores have been reported in the literature. Furthermore, to enable individualized risk estimation for long-term all-cause mortality, the Updated LCSS has been developed by combining the anatomical SYNTAX score and clinical factors.
In the randomized GLOBAL LEADERS trial, anatomical SYNTAX score analysis was performed by an independent angiographic corelab for the first 4,000 consecutive patients as a prespecified analysis; of these, 545 presented with STEMI. The efficacy of the mortality predictions of the four scores at 2 years were evaluated based on their discrimination and calibration abilities.
Complete data was available in 512 patients (93.9%). When the patients were stratified into two groups based on the median of the scores, the prewiring and postwiring Updated LCSSs demonstrated that the high-score groups were associated with higher rates of 2-year all-cause mortality compared to the low-score groups (6.6 vs. 1.2%; log-rank p = .001 and 6.6 vs. 1.2%; log-rank p = .001, respectively). There were no statistically significant differences for predicting the mortality between the prewiring (area under the curve [AUC] 0.625), postwiring MI-SYNTAX score (AUC 0.614), prewiring (AUC 0.755), and postwiring Updated LCSS (AUC 0.757). In the integrated discrimination improvement (IDI), the prewiring MI-SYNTAX score had a better discrimination for the mortality than the postwiring MI-SYNTAX score (IDI -0.0082; p = .029). The four scores had acceptable calibration abilities for 2-year all-cause mortality.
The prewiring Updated LCSS predicts long-term all-cause mortality with clearly useful discrimination and acceptable calibration. Since the postwiring MI-SYNTAX score does not improve mortality prediction, the prewiring MI-SYNTAX score may be preferred for the 2-year mortality prediction using the Updated LCSS.
比较经皮冠状动脉介入治疗（PCI）后 2 年全因死亡率的预布线、布线后 MI-SYNTAX 评分、预布线和布线后更新的逻辑临床 SYNTAX 评分（LCSS）在 ST 段抬高型心肌梗死（STEMI）患者中的预测性能。
在 STEMI 患者中进行直接 PCI 时，经常在恢复冠状动脉血流后观察到罪犯病变远端的冠状动脉狭窄。为了全面解决这些患者复杂的冠状动脉解剖结构，文献中已经报道了预布线和布线后的 MI-SYNTAX 评分。此外，为了能够对长期全因死亡率进行个体化风险评估，已经通过结合解剖学 SYNTAX 评分和临床因素开发了更新的 LCSS。
在随机 GLOBAL LEADERS 试验中，对前 4000 例连续患者的解剖学 SYNTAX 评分进行了独立的血管造影核心实验室分析；其中 545 例为 STEMI 患者。根据其区分度和校准能力评估了这四个评分在 2 年时预测死亡率的效果。
512 例患者（93.9%）可获得完整数据。当根据评分中位数将患者分为两组时，预布线和布线后更新的 LCSS 表明，高分组与 2 年全因死亡率较高相关，而低分组则较低（6.6%比 1.2%；log-rank p=0.001 和 6.6%比 1.2%；log-rank p=0.001，分别）。在预测死亡率方面，预布线（曲线下面积[AUC]0.625）、布线后 MI-SYNTAX 评分（AUC 0.614）、预布线（AUC 0.755）和布线后更新的 LCSS（AUC 0.757）之间没有统计学上的显著差异。在综合判别改善（IDI）方面，预布线 MI-SYNTAX 评分比布线后 MI-SYNTAX 评分具有更好的死亡率判别能力（IDI -0.0082；p=0.029）。这四个评分对于 2 年全因死亡率都有可接受的校准能力。
预布线更新的 LCSS 对长期全因死亡率具有明显有用的区分度和可接受的校准能力。由于布线后 MI-SYNTAX 评分不能改善死亡率预测，因此在使用更新的 LCSS 进行 2 年死亡率预测时，可能更倾向于预布线 MI-SYNTAX 评分。
